Dr. Brent Asplin is an emergency physician at Regions Hospital in St. Paul, MN; a research clinician at HealthPartners Research Foundation; and Assistant Professor of Emergency Medicine at the University of Minnesota. This award will provide a foundation for Dr. Asplin?s future work as an independent health services researcher. Dr. Nicole Lurie, Special Advisor to the Dean of the University of MN Medical School and Medical Advisor to the MN Commissioner of Health, will mentor him during this award. Dr. Lurie is a nationally prominent health services researcher with extensive research experience in the areas of access to care, health disparities, and the health care safety net. She has research experience in the emergency department (ED) setting and also is ideally positioned to maximize the policy impact of Dr. Asplin?s research activities. HealthPartners Research Foundation (HPRF) will provide institutional support for Dr. Asplin during the award period. HPRF is a non-profit public domain research institution with an annual research budget over $9 million. Despite reports that ED crowding is widespread and serious, no empirical work exists to define ED crowding, demonstrate its consequences, or propose solutions. This application includes research projects for each of three factors that contribute to ED crowding: input, throughput, and output factors. Project CHANGE will determine if an Advanced Access (AA) appointment system in the HealthPartners Medical Group (HPMG) reduces ED utilization rates. The ED Crowding Project has the following primary specific aim: To develop feasible and reproducible measures of ED crowding. Administrative and survey data will be collected in two phases at eight EDs. The reasons for ED crowding will be categorized as input, throughput, or output. The relationship between ED crowding and hospital inpatient bed availability will be studied, and adverse events associated with crowding will be described. The ED Access Project has the following primary specific aim: To determine the availability and timing of outpatient appointments for medical and surgical conditions requiring urgent ED followup care according to insurance status. A national telephone survey will be conducted assessing the availability of urgent follow-up appointments for patients with private insurance, Medicaid, or no insurance.